Local services
Ensuring quality of local services
Quality of provision
Our proportion of home care services rated ‘Outstanding’ or ‘Good’ by CQC is higher than the England average at 91% compared to 88%, although our care homes market is slightly under the England average at 80% ‘Outstanding’ and ‘Good’, compared to 85% for England. Our structures and work programmes support good practice and a focus on continuous improvement in quality across our services. Through spring 2024, we reviewed our approach to contract management across Adults Commissioning and put in place a new policy for contract management which ensures our approach across all services within the department are consistent and proportionate to risk and resources. This new approach began implementation in the summer and our leadership team will be updated quarterly on risks in the care market arising from contract management, the mitigations in place to manage these and support to contractors to maintain good performance and regulatory compliance. We have five internally provided learning disability care homes, four are rated Good, one is Requires Improvement which has an action plan in place to improve against the areas CQC highlighted for attention. We have one older people with dementia service that also has a good rating. Our Shared Lives Scheme is Good overall and holds an Outstanding rating in ‘Caring’.
Our recently restructured Quality Assurance and Market Support (QAMS) team provides both proactive support to the market to develop, and reactive support when providers are struggling in terms of quality issues or risk of provider failure. This is achieved through various methods including sharing good practice, building resilience through contingency planning, individual action planning and providing expert advice and guidance. An example of the proactive work supported through this team, and in close partnership with our active West Sussex Providers in Care Forum (WSPiC) is highlighted in the spotlight on the Great Care Employer scheme.
This has enabled us to understand the care provider challenges and work together to find solutions, encouraged engagement, enabled feedback, and provided a platform to trial innovative solutions, such as a trusted assessor in hospitals.
We also have a Quality Assurance and Safeguarding Information subgroup which develops and maintains a single picture of the quality and safety of the local care market. It seeks to improve the safety of services through early information sharing and intervention within appropriate systems e.g. regulation, quality monitoring, safeguarding and other governance systems and plays a key role in prevention.
Ensuring local services are sustainable
Through a mix of financial investment and support, the market in West Sussex is becoming resilient and developing and growing to meet the needs of residents. Over the past 3 years there has been a conscious focus on ensuring a level of uplift which accommodates the increasing costs the care market has been impacted by including National Living Wage, but also on ensuring sustainability by increasing to levels of on average 8-9%. The average rates the council is paying in non residential services reflects the strategic importance of supporting people at home wherever possible and has encouraged growth in the market and capacity in service availability. Capacity in care at home has improved significantly and remained stable over the course of that time as providers have benefitted from rate increases, and support to retain staff and recruit staff both locally and internationally.
We have benefitted more recently at lower levels of contract handbacks with only 10 handed back in the last 12 months. Providers are actively supported when they do exit the market to ensure smooth transitions and reduce disruption where possible for customers. As a preventative measure, the council’s Quality Assurance and Market Support team provides proactive support to providers through forums, signposting, sharing of learning and forums as well as 1-1 support for individual providers. On a more reactive basis, there is a plan for managing emergency provider failure in both residential and non-residential services and the council is experienced in managing provider failure, including working alongside multiple agencies to ensure the safety and continuity of care for customers and residents.
A recent exercise for DHSC identified that out of 193 providers responding, there were 431 new recruits in April 2024 and 265 leaving a job in care, and hence there is a net positive position on recruitment currently. The increase in international recruitment has proved to be a very positive opportunity to increase the number of care workers in West Sussex. However, it has come with some challenges and risks including providers not adhering to regulations resulting in revocation of licenses. The council is working with West Sussex Partners in Care (WSPiC) and provider representatives to set out an approach that is proactive (supporting and encouraging good ethical recruitment and staff practices and ensuring providers are aware of regulation obligations) monitoring (being aware of potential risks, and monitoring practice) and reactive (reporting concerns, emergency planning and taking contractual action as required) and is sharing learning with neighbouring authorities to support development in this area.
The Council works closely with the West Sussex provider forum WSPiC on a range of areas beyond international recruitment. We have an active working relationship, sharing key areas of work for their input and co-producing with them where possible and appropriate, including on our contract management approach, the Market Sustainability Plan and development of a strategic provider forum. The council has supported the WSPiC Care Accolades celebrating both individuals and collectively the care workforce in West Sussex.
There are however some areas where we are aware more needs to be done to develop the market to be able to respond to both current and future need, particularly, for example, in the lifelong services and mental health areas of the business. Investment has been made which has created two dedicated posts to focus on working with providers to stimulate development of new and innovative schemes for people with learning disabilities and mental health needs. To date we have held 4 market engagement events for mental health providers and 4 for providers of life-long services, with multiple offers to co-design support. These have also led to the development of a pathway project working collaboratively with the provider market to develop a toolkit to enable customers to move through services as they increase their independence. This is in the early stages but is starting to show positive impact on the market.
Short term investment has been allocated from hospital discharge system funding to enable rapid implementation of new schemes to support timely discharge from mental health in-patient units. Capacity in hospital discharge services has been supported through hospital discharge funds and commissioning approaches enabling block opportunities to support development and growth, as well as enable capacity.
As acknowledged, the council recognises some areas of the market require further development. However, we believe that we are in a good position to support sustainability in care going forward, with a historic focus on sustainable rates, a new commissioning strategy and Market Position Statements being developed to give clarity to the market on future direction, with positive commissioning approaches and developments and good levels of market engagement.